I will say this from the start, if there is a medication out there that will help a patient fix SIBO and the daily, often debilitating symptoms that they are experiencing, I am first in line. I also want people to recover – long term. Though I have seen xifaxan and the combination of xifaxan and neomycin work for some people, it seems like these are successful at knocking down SIBO long term for only a very small percentage of people.

Prior to meeting with a new SIBO patient I spend around 45 minutes combing through all the labs, intake paperwork and health history timeline in preparation for our intake session. It is extremely common for me to see a new patient who has undergone four and five, or more rounds of antibiotics, trying to knock out SIBO.

During the intake session, I get to hear firsthand, the experience that the patient has had with each of these successive rounds of antibiotics. There are two patterns that I see with patients.

The first pattern that I see is that they go on an antibiotic and they don’t feel much better. So, the doctor tries again with another prescription – maybe the same antibiotic, a higher dose, they’ll recommend that they take it longer (I’ve seen people prescribed Xifaxan for a full month), or they may now recommend a combination of antibiotics or another antibiotic altogether. This goes on and on with multiple rounds. Unfortunately the patient doesn’t respond well to the treatment.

"Do Antibiotics Do More Harm Than Good Treating SIBO? Reading a great post on SIBO Guru"

I realize that the goal is to treat SIBO with an antibiotic and knock it down so the patient can recover from this, yet, there are so many people that are not responding well to this line of treatment… and in the end, all of these rounds of antibiotics are going to make it harder for a person to recover the balance in their gut.

I have seen emails and letters from GI docs to their patients stating that they have done everything they can and they don’t have another form of treatment to offer. I have seen another stating that they recommend monthly xifaxan and erythromycin for life – they recommend A MONTHLY ANTIOBIOTIC.

The second pattern that I see is this – they go on an antibiotic and they finally feel good. Their symptoms seem to resolve quickly and they feel better for the length of time that they take the antibiotic.

Then, often within two-four weeks, the symptoms begin to slowly creep back in. This happens slowly. At first, the symptoms are a little unsettling, but compared to what they were experiencing prior to treatment, they are still in a very good place.

A little time will go by and now the symptoms fully return and they are ready to do another round of antibiotics. The doctor, thinking that the initial treatment didn’t work, may prescribe the same antibiotic, a higher dose, recommend that they take it longer, or they may now recommend a combination of antibiotics or another antibiotic altogether.

This time, during the antibiotic treatment, they don’t feel as much recovery and they often feel fatigued during treatment. After treatment, they still see some symptoms. And, with each successive treatment, symptoms begin to worsen over time and these symptoms become harder to recover.

SIBO is a symptom of an extreme imbalance in the gut. Treating SIBO with an antibiotic is like having a bomb go off in you digestive tract. Any semblance of balance that the commensal flora was holding onto with their fingernails has just been upturned.

Additionally, treating SIBO with antibiotics will also do nothing to address fungal imbalances in the gut. You don’t usually hear a lot about this – but two large studies have shown that, of the over 100+ subjects in each study, around 2/3 of the subjects reporting classic SIBO symptoms had SIFO (small intestinal fungal overgrowth) which was identified with a duodenal aspirate, where fluid was taken at the very proximal, or near, part of the small intestine; right on the other side of the stomach. This is the part of the intestinal tract that should house the least amount of flora and be free of yeast.

Treating SIBO with an antibiotic, or multiple rounds of antibiotics, will clear the way for a fungal imbalance to take hold in the digestive tract.

This is why I prefer to address SIBO with herbs that are both antimicrobial and antifungal. Once SIBO is knocked down, and your symptoms have recovered, this simply marks the first phase of treatment.

Steps still need to be taken to address the underlying factors that set the stage for SIBO in the first place. If each of these items is not addressed, SIBO will likely reoccur and then you are back to square one: you need to support digestion at every step, heal the gut lining, repair the damage SIBO has caused, systematically rebalance the gut flora, address mucosal immune dysfunction, and address gut motility. Once these have all been addressed, then you can begin to expand from a LOW fermentable SIBO eating plan and begin to test out known trigger foods.

Healing SIBO takes time, but it can be done!!

Angela Pifer, SIBO Guru

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Comments

from 20 people

I am so sorry to hear this Christina. I don't have anyone to recommend in New York. There are a few of us who work long distance. Try Dr. Kelley Reis in North Carolina, Dr. Siebecker, Dr. Keller in Beverly Hills are among them, as well as myself.

Angela Pifer | March 28, 2018

Hi my name is Christina and I’ve been recently diagnosed with sibo. I live in NY and I’m trying to find a doctor that can help me with this problem. After 3 years of going to different doctors I finally found one who was able to diagnose me. But as for treatment, he’s basically useless.... if you have any recommendations I would greatly appreciate it. Thanks so much!!!

Christina | March 21, 2018

Hi BB - After c diff the system is in such a sensitive place. There is a lot to recover and we have to be very careful that new treatments don't tip the balance again (the risk of getting c diff again is very high). I can appreciate the effort that you are putting into this. Look up http://ndnr.com/gastrointestinal/chronic-diarrhea-after-c-difficile-eradication/ - this is a good article to read through. I hope that it helps!

Angela Pifer | March 10, 2018

I was so excited to have found you. I’m a stage 4 Breast cancer survivor... I’ve had so many surgeries chemo bone marrow transplant double mastectomy total hysterectomy spinal fusion three knee surgeries need another spinal fusion emergency appendectomy micro bacterium avian complex etc etc. I’ve contacted c-diff twice and now I have this SIBO again. I’m so scared to take the Xifaxan they are telling me I now need for fear that it will bring back the dreaded c-diff. I have a horrible immune system. I don’t know what to do or where to turn. I’m very low income and feel just horrible. If you can help me at all I would be so grateful. I’ve been trough so much .... I try so hard to feel and get better. Thank you

BB | February 27, 2018

Hi Judy,
This is just bad advice. Since you have methane and hydrogen, you treat methane and you can't do this with rifaximin alone. Of course it 'came back' - respectfully (and I am sorry for your experience) it never went away. It wasn't treated correctly. With Cipro, there is a concern of getting c. diff. I don't recommend this.

The correct way to treat methane is to take rifaximin with flagyl or neomycin and you need to retest to make sure that this is gone.

Herbs absolutely, positively do work. Methane is harder to knock out period, so this isn't easily accomplished with one round of herbs. Your number of rounds will be based on your parts per million methane and how many rounds (one month round per herb protocol) it will take to bring this below 3ppm. Then your will have equally as long to spend working on gut healing, immune modulation and rebalancing the gut.

You must find a practitioner to work with you while you are on these rounds. I fully appreciate that there are blogs like mine, and chat rooms available, sharing information, but honestly - each patient that I work with has a customized plan, approach, different herbs (types, combinations and dosages) and then you need to track progress and adjust the protocol over time. SIBO is also a secondary condition, so you need to be assessed for readiness to address this and then the underlying issue must also be addressed, or this will likely come back.

I have never heard of a patient taking Cipro and knocking this out long term.

I do work long distance with my patients. If you cannot find a practitioner in your area, I am happy to work with you.

Warmly
Angela

Angela Pifer | July 31, 2016

Hi Angela! I have methane and hydrogen sibo, as well as Candida. I am seeing a functional dr who prescribed rixafaxin but it came back. She just put me on two weeks of cipro. Said herbals will not work, but I am terrified after reading about the serious side effects of cipro. Help! I do not know if I should take the cipro or not!! And there are no other practitioners where I live. Thank you! Judy

Judy | July 31, 2016

Hi Beth,

Most all the probiotics that I use are listed under my shop https://siboguru.com/product-category/probiotics/https://siboguru.com/product-category/probiotics/ you don’t need to purchase these from me. This is just a good reference so you see what I use with my patients.

Warmly,
Angela

Angela Pifer | July 23, 2016

What is the recommended best probiotic that YOU would tell your clients to take for sibo? Do u recommend taking probiotic while on atb therapy of rifaxan and neomycin . Just starting atb please help. Thanks for you time and expertise. Beth

beth | June 11, 2016

Hi Sandy,

Thank you for sharing all of this - I greatly appreciate your question here and that you are looking for a natural way to treat this. I cannot recommend a treatment plan to you because I am not working with you one on one. Each protocol is different for every patient that I work with. I really don't have a canned approach that I use each time.

Black walnut and wormwood are very good to use with fungal issues, but not with SIBO. A parasite cleanse will not fix SIBO. Unfortunately, neither will the amoxicillin that your doctor gave you. If you are going to go the antibiotic route and there is methane SIBO present, then you would need xifaxan and to combine this with another antibiotic. Simply trying single antibiotic, after single antibiotic will not fix a methane issue and over time, you will likely lose some endurance in your gut.

This all said - and I promise that I am not trying to frustrate you here, chronic gastritis can cause a false positive SIBO breath test. It does sound like you need to address gut dysbiosis. I would look for a practitioner to work with who will help you figure this out. I am happy to work with you (I work long distance via Skype video): https://siboguru.com/contact/

Warmly

Angela

Angela Pifer | July 23, 2016

My name is Sandy, I need your help. I live in PA area and about around July 2009. I was cooking some pork for my family. It smelled really bad so I tasted it not to long after I was throwing up and sweating and was really hot. Next day I had a fever.

For the next 4 years everything I ate burned my lower right quadrant and gave me really bad gas and aches. Around June of 2014 I had an endoscopy I was diagnosed with chronic inactive gastritis. Was given antibiotics for gas but the burning was still there.

In March of 2015 had a colonoscopy and and I had elevated eosinophils in a crypt in left and right colon.

In June 6th 2015 I had an allergy test no results back yet still waiting.

Finally June 11th 2015 I took a hydrogen breath test and the results came back positive for Bacterial Overgrowth. My results showed levels of methane but the hydrogen levels were through the roof. I still don't understand the results.

My question to you is ....what are some good natural cures for Bacterial overgrowth?..I bought some black walnut hulls and wormwood and cloves and was thinking of doing a parasite cleanse even though my stool test came back negative.

My doctor have prescribe probiotics amoxicillin which was for a week and did not work and my intestines still burn after eating after taking the amoxicillin for a week. I was also approved for xifaxin later and was told if amoxicillin doesn't work wait two weeks and take the xifaxin, but I don't think this will do anything for me either as I think it will make things worst and won't solve the problem.

What should I do?....please help!!!!

Sandy | April 11, 2016

Hi Christina,
I haven't seen fluconazole trigger SIBO, though I hear that this is the point that your digestion remarkably changed. This medicine is an anti-fungal. It is not an anti-biotic. So following up with a probiotic, wouldn't have really helped with this. I am more concerned over why you had a rash, what triggered this (and would have tried to address this topically with medication/ creams and then addressed the underlying reason why this happened - perhaps a food allergy, dysbiosis, immune response (or combination of these).

When you have a colonoscopy (although it feels that you are squeaky clean :) you still have plenty of flora residing in biofilm along the digestive tract. You clean out the lumen (the center) but don't affect the biofilm much. This does knock down microbe levels for a period of time and it makes sense that your symptoms came back after a few weeks - after a period of time of these microbes.

The Whole30 plan will not help address gut symptoms (if this is indeed SIBO). I would look more to a low FODMAP plan to help with this, but only advise that this is used for a short duration during the treatment protocol to address SIBO.

I recommend the 3 hour lactulose test for hydrogen and methane for the breath test. I am happy to work with you! I have a bit of a waiting list, so if you would like to join the waiting list, follow the 'work with me' tab and enter your info to be added to the list.

Warmly

Angela

Angela Pifer | November 2, 2015

Hi Angela,

I'm new around here and so far, really loving your info! After several months of digestive discomfort, I tested for Crohns and Colitis, both coming back negative and landing with an IBS-D diagnosis. However, the worst part isn't even the bathroom trips, those aren't really that frequent. It's the bloating and constant gurgling I feel, like I can actually feel digestion happening. My gastro is very open to diet based treatment, so I may ask if he is able to do a SIBO test. When I was telling and showing him where I felt the most discomfort, he even mentioned that was my small intestine, so I feel like I may have hit the nail on the head.

I can pinpoint when this all started, several months ago I saw an urgent care for a rash they said was a yeast infection. I used a nystatin cream plus FIVE days of fluconozale by mouth! I had no idea until after how damaging that was. I had terrible digestive issues during, and they continued, though less severe, after. I never knew the effect the anti-fungal had, so of course I didn't do any follow up via diet or probiotics. Then, months later, after cleaning out for my colonoscopy, that was the best I had ever felt. But again, I didn't know or think that hey, that just cleaned out EVERY LIVING THING in your digestive tract. So sure enough... a few weeks later, the symptoms returned, though not as severe, still so uncomfortable.

I started a Whole30, and 5 days in hadn't had any discomfort or issues. Then I had a slice of cookie cake and it was like starting all over again.

I guess my question would be, approx how long does it take to heal the gut/sibo? Or do you just go by breath tests periodically?

I live in Oklahaoma, naturopath's are not really a thing here. I think I saw you do long distance help, which I really may look into after I speak to my gastro! Meanwhile, I bought a probiotic with specific strains you mentioned (and no prebiotics) and am going to ease into a low fodmap diet.

Thanks again!

Cristina O. | October 13, 2015

Angela I so appreciate your generous response. I know this venue is
time consuming for your already busy schedule.
I will take your advice into action. I realize after reading some of the blogpost replies that i should
address a subclinical adrenal problem first before hitting the sibo head on.
(dang it-one more thing)

L gordon | September 28, 2015

Hi Nellie,
I am so sorry to hear how you are struggling with this. SIBO itself is really a symptom, more than a diagnosis. To treat this correctly, a thorough investigation needs to be done, into why this was set up in the first place. These factors need to be addressed at the same time. I really use diet to calm symptoms (the Skinny Gut diet will not help with SIBO). I would look more to a FODMAP plan to help calm your symptoms. The treatment for SIBO needs to be targeted (at the right dose, duration and the right herbs to address YOUR SIBO - the level, type, other symptoms/ conditions that are contributing to this). There isn't perfect 'SIBO treatment' out there. If you are using Xifaxan to keep symptoms at bay (you mention taking it once a month) I strongly disagree with this approach. Over time, I feel that this will make things worse and not better. You can and will get your life back. It sounds like you need to search for a new practitioner to work with, who can target this better and help you address your symptoms while going through treatment. Best of luck to you...
Angela

Angela Pifer | November 2, 2015

After 2 years dealing with horrible stomach issues, weight gain of over 20 pounds, lots of tests to include colonoscopy, endoscopy, cat scans, blood work, and 7 doctors later, I have been diagnosed with SIBO. I cannot eat anything without my stomaching blowing up, it's so uncomfortable, I no longer have a good quality of life. I started the diet from the book The Skinny Gut but could only follow it for a week. I take probiotics, I take Xifixan once a month but it does not help me, my stomach distension is so uncomfortable, clothes never fit. I take all types of herbs, digestive medicines etc. Will I ever get my life back?

Nellie | September 27, 2015

Hi L Gordon, I address SIBO and candida at the same time. This isn't hard to do, since many of the herbs that address SIBO can also address candida (they are both antifungal and antimicrobial). The bottom line is that you have intense dysbiosis that needs to be addressed. I recommend working through SIBO treatment for a month, then pull off the herbs, retest the breath test (get a baseline breath test now) - you need to see how effective the first round of herbs is. Expect 20ppm reduction in gas with each 30 day protocol. You will need to be on a three month protocol to treat yeast.

C.diff is a bit different and harder to knock out. I recommend a c.diff lab with your provider (do not go off the organic acids panel with this). I will be opening up a few new appointments in the next two weeks. Be sure to sign up for the waiting list through SIBOGuru.com and I'll let you know when these come available.

Warmly
Angela

Angela Pifer | September 12, 2015

I have a burning question. I am newly seeing a naturopath who after the organic acid test states that I am highly intolerant of gluten and casein -I have sibo/candida/c-diff.
I came to them because my insurance covered part of the care. They want to do antibiotics/antifungals for my condition. I am not interested in the abx because I feel my dysbiosis caused my problems in the first place. ( chronic recurrent diverticulitis )
I am hoping to use herbals and such for treatment and hoping to stear my ND that direction.
bottom line --
what do you endeavor to treat first. Sibo or Yeast overgrowth? (c-diff with no diarrhea?

I really like your 'root cause' approach to gut issues and wish I had known about your
practice sooner as I am in the area.

L gordon | September 12, 2015

My name is Sandy, I need your help. I live in PA area and about around July 2009. I was cooking some pork for my family. It smelled really bad so I tasted it not to long after I was throwing up and sweating and was really hot. Next day I had a fever.

For the next 4 years everything I ate burned my lower right quadrant and gave me really bad gas and aches. Around June of 2014 I had an endoscopy I was diagnosed with chronic inactive gastritis. Was given antibiotics for gas but the burning was still there.

In March of 2015 had a colonoscopy and and I had elevated eosinophils in a crypt in left and right colon.

In June 6th 2015 I had an allergy test no results back yet still waiting.

Finally June 11th 2015 I took a hydrogen breath test and the results came back positive for Bacterial Overgrowth. My results showed levels of methane but the hydrogen levels were through the roof. I still don't understand the results.

My question to you is ....what are some good natural cures for Bacterial overgrowth?..I bought some black walnut hulls and wormwood and cloves and was thinking of doing a parasite cleanse even though my stool test came back negative.

My doctor have prescribe probiotics amoxicillin which was for a week and did not work and my intestines still burn after eating after taking the amoxicillin for a week. I was also approved for xifaxin later and was told if amoxicillin doesn't work wait two weeks and take the xifaxin, but I don't think this will do anything for me either as I think it will make things worst and won't solve the problem.

What should I do?....please help!!!!

Sandy | July 14, 2015

Hi Dar,
This is a very common experience... I definitely wouldn't take 300 mg zantac, there are other ways to heal your esophagus without further knocking down stomach acid, which will then increase your likelihood of SIBO reoccurrence. Unfortunately I can't make the recommendation on what to start and stop without knowing your whole case. I do feel that probiotics are a must, so is supporting digestion, healing your digestive track... etc.

I work locally and long distance (over 80% of my patients are working with me long distance). I wish you the best of luck!

Angela

Angela Pifer | May 5, 2015

I took xifaxin in December and my SIBO symptoms went away. After that I took probiotics. I recently got the symptoms back again and now on 55o mg 3 times daily. I did well before but now have dry mouth, white tongue and fatigue. I have been on this dose for only 4 days. I Am supposed to take it for 3 weeks. I feel horrible off of xifaxin but now am feeling bad on it., except after two days my gut feels good.I am on 300 mg zantac a day for Barretts. I think ppi treatment caused the SIBO, but doc says I have to at least take zantac. With my tongue and mouth issue should I get off it or add probiotics to it. Thank you so much. Do you know any dieticians that treat SIBO in Connecticut?